title: [Nephrotoxicity and long-term treatment with lithium].
abstract: With particular focus on clinical, pathophysiologic and epidemiologic aspects this systematic review article presents the available data on nephrotoxic effects of a long-term treatment with lithium. Lithium may lead to tubular dysfunction (LITD = nephrogenic diabetes insipidus, hyperchloremic metabolic acidosis, increased natriuresis) and lithium-induced nephropathy (LIN) with reduced glomerular filtration rate (GFR). The histopathologic finding of LIN is chronic tubulo-interstitial nephritis. LITD frequently presents with polydipsia/-uria and reduced urine osmolality, while LIN features a wide clinical spectrum ranging from clinically asymptomatic presentations with reduced GFR to end-stage renal failure. LIN seems to feature slow progression and is significantly less frequent than LITD. Regular monitoring of renal function is indispensable for patients treated with lithium. Patients with reduced GFR under treatment with lithium should always be presented to a nephrologist. Currently, there are no guidelines for the handling of patients with LIN and ongoing treatment with lithium. Thus, regarding continuation of lithium-treatment an individual benefit/risk assessment is necessary.
authors.affiliation: Klinik für Psychiatrie und Psychotherapie III, Universitätsklinikum Ulm.
authors.forename: Maximilian
authors.initials: M
authors.lastname: Gahr
authors.affiliation: Klinik für Psychiatrie und Psychotherapie III, Universitätsklinikum Ulm.
authors.forename: Roland W
authors.initials: RW
authors.lastname: Freudenmann
authors.affiliation: Klinik für Psychiatrie und Psychotherapie III, Universitätsklinikum Ulm.
authors.forename: Bernhard J
authors.initials: BJ
authors.lastname: Connemann
authors.affiliation: Abteilung Innere Medizin I, Sektion Nephrologie, Universitätsklinikum Ulm.
authors.forename: Frieder
authors.initials: F
authors.lastname: Keller
authors.affiliation: Klinik für Psychiatrie und Psychotherapie III, Universitätsklinikum Ulm.
authors.forename: Carlos
authors.initials: C
authors.lastname: Schönfeldt-Lecuona
mesh_terms: D001714:Bipolar Disorder / Q000097:blood / Q000188:drug therapy*; D018500:Diabetes Insipidus, Nephrogenic / Q000139:chemically induced* / Q000473:pathology / Q000503:physiopathology; D016903:Drug Monitoring; D005919:Glomerular Filtration Rate / Q000187:drug effects / Q000502:physiology; D006801:Humans; D007668:Kidney / Q000187:drug effects / Q000473:pathology / Q000503:physiopathology; D007671:Kidney Concentrating Ability / Q000187:drug effects / Q000502:physiology; D007676:Kidney Failure, Chronic / Q000139:chemically induced* / Q000473:pathology / Q000503:physiopathology; D007677:Kidney Function Tests; D018020:Lithium Compounds / Q000493:pharmacokinetics / Q000627:therapeutic use / Q000633:toxicity*; D008134:Long-Term Care; D009318:Natriuresis / Q000187:drug effects / Q000502:physiology; D009395:Nephritis, Interstitial / Q000139:chemically induced* / Q000473:pathology / Q000503:physiopathology; D012017:Referral and Consultation; D014882:Water-Electrolyte Balance / Q000187:drug effects / Q000502:physiology
chemical_list: D018020:Lithium Compounds